Hematology AdvisorLong-Distance Endurance Running May Impact Red Blood Cell Aging

A multiomics analysis of 23 athletes found that ultra-marathon running accelerates RBC aging through inflammatory and oxidative pathways. RBC damage signals correlated with distance and time under load, with ultra-runners showing impaired deformability, elevated copper, and signs of splenic clearance of damaged RBCs.

Clinical Considerations

• Accelerated RBC aging in ultra-runners mirrors mechanisms observed during blood storage, offering translational relevance to transfusion medicine
• Interleukin-6, kynurenine, and acute-phase proteins were markedly elevated in 171-km runners versus 40-km runners
• Impaired RBC deformability and long-chain acylcarnitine accumulation signal prolonged oxidative stress adaptation in ultra-runners
• Both race distances produced increased immature reticulocytes and reduced mean cell volume, suggesting compensatory erythropoietic response

Practice Applications

• Consider endurance sport history when evaluating unexplained hematologic findings in active patients
• Counsel patients with hemolytic conditions on cumulative RBC stress risks of extreme endurance events
• Apply oxidative pathway insights from this research to blood storage optimization investigations
• Monitor for splenic clearance markers in ultra-endurance athletes presenting with fatigue or anemia

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